VA to improve access to health care services in the Pacific Islands

| April 17, 2018 | 0 Comments
VA logo

VA logo

VA Pacific Islands Health Care System
News Release

HONOLULU — In response to a report released by the Government Accountability Office’s (GAO), “Improving Access to Health Care Services in the Pacific Islands,” the Veterans Affairs Health Care System (VAPIHCS) released the following statements.

The GAO study found that the remote nature of the Pacific Islands creates some unique challenges for VAPIHCS, which may affect its ability to provide the approximately 50,000 veterans it serves in American Samoa, Guam, Hawaii and the Commonwealth of the Northern Mariana Islands with timely access to primary, mental health and specialty care.

The report included a provision for GAO to review VHA’s efforts to provide timely access to health care within VAPIHCS. Among other things, this report examines the following: the extent to which the VAPIHCS veterans received (1) timely primary and mental health care, and (2) timely specialty care, and (3) any challenges VAPIHCS faced in recruiting and retaining physicians, and strategies used to resolve them.

GAO reviewed relevant policy documents, reviewed a randomly selected, non-generalizable sample of 164 medical records and interviewed Veteran Health Administration (VHA), VAPIHCS and Department of Defense (DOD) officials.

VAPIHCS

VAPIHCS

VAPIHCS appreciates the work of the GAO. This report confirms that despite unique challenges, VAPIHCS has made significant improvements to its processes and practices, as well as to levels and types of employees to increase access to care.

The report found that the majority of VAPIHCS patients reviewed, received primary care and mental health services within timeliness goals set by VA’s VHA. The report also identified some opportunities for improvement, and VA’s initial response to the findings follow:

Recommendation 1. The Secretary of VA should ensure that VAPIHCS review its referral process for referrals to DOD providers, including referral cancellation, to determine why VHA policy is not being adhered to and make changes as needed

What’s being done: VAPIHCS has reviewed its process to refer veterans to DOD providers and revised the procedure. Specifically, for Tripler Army Medical Center (TAMC) the procedure was changed for scheduling attempts. TAMC now schedules all veterans that are referred to TAMC.

If TAMC is unable to contact the veteran within three days of receipt of the consult, the consult will be returned to VAPIHCS for further action. To remedy inconsistencies in consult management practices, VAPIHCS Care in the Community (CITC) staff underwent refresher training Feb. 15, 2018. The training focused on appropriate reasons for cancelling consults, as well as which staff are authorized to cancel consults.

Guam CBDC

Guam CBDC

Only registered nurses have the authority to cancel consults. Effective March 2018, the CITC Nurse Manager will conduct monthly audits of cancelled consults to ensure adherence. The audits will continue until VAPIHCS achieves a minimum of 90 percent adherence rate over three consecutive months.

Recommendation 2. The Secretary of VA should ensure that VAPIHCS clarify guidance to clearly define and document roles and responsibilities for VAPIHCS staff involved in the referral process with U.S. Naval Hospital Guam (NHG).

What’s being done: VAPIHCS has defined the roles and responsibilities for VAPIHCS staff involved in the referral process with NHG. VAPIHCS Care in the Community staff are operating under National Care Coordinator functional statements, which define their roles and responsibilities.

VAPIHCS will develop a signed memorandum of understanding with NHG to clearly define the roles and responsibilities of all staff. These roles and these responsibilities will be added to the existing sharing agreement between VAPIHCS and NHG.

VA Honolulu

VA Honolulu

Recommendation 3. The Secretary of VA should ensure that VAPIHCS improves the monitoring of referrals and communication with Naval Hospital Guam (NHG) to ensure the timely management of referrals to NHG, including verifying the availability of services for Veterans; ensuring referrals are entered into NHG’s electronic medical record system; and obtaining information about the status of scheduling appointments for veterans.

What’s being done: VAPIHCS agrees with improving the monitoring of referrals to NHG by verifying the availability of services for veterans and obtaining the status of scheduling appointments for veterans. VAPIHCS is developing a standard operating procedure for referral notification, disposition, scheduling and completion, with monitoring of referrals weekly to resolve issues. VAPIHCS will collaborate with NHG to monitor the availability and status of services and appointments and follow-up on discrepancies.

VAPIHCS does not agree with ensuring referrals are entered into NHG’s electronic medical record system. VA does not have any authority to monitor NHG’s electronic medical record system and does not concur with this part of the recommendation.

As long as VAPIHCS staff continue to be responsible for entering referrals into NHG’s electronic medical record system, we believe that it will be our responsibility to monitor the status of these referrals, including ensuring that referrals are entered correctly and timely.  VAPIHCS is currently working to develop a process to improve the monitoring of referrals to NHG.

GAO reports

GAO reports

Recommendation 4. The Secretary of VA should ensure that VAPIHCS evaluates the effectiveness of strategies it currently uses to promote physician recruitment and retention, including how the strategies could be improved. The plan should also include an assessment of whether additional strategies currently offered by VHA would be beneficial.

What’s being done: VAPIHCS is organizing a Systems Re-Design project that will bring together a multi-disciplinary group of staff and leadership to review our recruitment strategies, actions and outcomes. The facility will consult with VA Workforce Management to determine any further strategies that can be implemented. A lessons-learned approach from this process will be adopted, reviewing best practices and developing specific actions.

Additionally, exit interviews involving departing VA providers will be scheduled to assist with identifying targeted actions to improve retention.

VAPIHCS has already identified several best practices related to physician recruitment and retention by implementing a systems-redesign best practice to ensure sufficient recruitment and retention are in place.  Additionally, exit interviews involving departing VA providers will be scheduled to assist with identifying targeted actions to improve retention.

“VAPIHCS is committed to improving our veterans’ experience,” said Jennifer Gutowski, director VAPIHCS. “We want them to choose VA to receive their care, because they want to, not because they have to. We will continue to work with our partners in the community to implement the changes we all agree need to be made.”

The Report: To read the entire GAO report, go to https://www.gao.gov/products/GAO-18-288.

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Category: Health

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